Individual
MR. TATE THOMAS REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1095 HIGHWAY 15 S, HUTCHINSON, MN 55350-5000
(320) 484-4400
Mailing address
1431 PREMIER DR, MANKATO, MN 56001-6076
(507) 386-6600
(507) 386-0252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11104
MN PA LICENSE
MN
01
—
1704
MN PA LICENSE
MN
Enumeration date
04/30/2010
Last updated
05/16/2012
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